Acne Imposters & Related Conditions

Because acne occasionally accompanies another skin condition, it can often be mistaken for the condition or vice versa.  Some of these conditions are simply tagalongs, like dandruff, while others may actually be mistaken for acne.  Learning about these conditions can help you formulate questions for your physician as you search for acne treatments.

Acne Cosmetica. As the name suggests, this mild and relatively common form of acne is caused by cosmetics. Because it is triggered by topical skin care products, it can affect anyone, even those who are not pedisposed to acne.  It typically consists of small, itchy red or pink bumps on the cheeks, chin and forehead.  The bumps develop gradually over weeks or months, but may persist indefinitely.  To avoid acne cometica search for oil and lanolin free products that are labeled "non-comedogenic." These products are less likely to cause irritation or clogging of the pores.

Dandruff (or Seborrheic Dermatitis). Dandruff is characterized by flaking and itching of the scalp.  For dandruff sufferers, the natural process of scalp-cell renewal is accelerated when fighting off P.ovale, a normal fungus found on every human head. This causes dead scalp cells to slough more quickly, creating the symptoms we know as dandruff — flaking, scaling and itching.  Because of the aggresive exfoliation of scalp scale (dead skin cells) acne accompany dandruff.  When aggressive exfoliation of scalp scale occurs, it is difficult for the body to remove the dead skin cells from hair follicles quickly enough to prevent blockage.   Climate, heredity, diet, hormones and stress can impact dandruff and most cases can be managed with non-prescription shampoos containing zinc, coal tar or salicylic acid. Stronger shampoos can be prescribed by your physician if the problem continues.

Dermatitis (or Eczema) is characterized by a rapidly spreading red rash which may be itchy, blistered and swollen.  Atopic dermatitis is related to asthma and hay fever allergies, and often manifests in early childhood. Contact dermatitis is usually caused by contact with irritants (detergents or harsh chemicals) or allergens (substance to which the patient is allergic, like rubber, preservatives or a particular fragrance).  Those with chronic dermatitis often have a ongoing history of irritation on or around the eyelids, neck and hands. The skin in these areas can be darker than surrounding skin, and thickened from persistent scratching. This form of dermatitis is thought to be hereditary, but may be influenced by environmental factors as well.  The bumpy texture of dermatitis is often mistaken for acne.

Enlarged Pores. Before the onset of puberty, most children have small pores and smooth skin. Pores tend to become larger during adolescence as sebum production increases. As we age, sun damage can decrease elasticity of the skin, making pores appear larger. Individuals with larger pores may also complain of small grayish blackheads on the nose and cheeks. Contrary to popular belief, these "blackheads" may be nothing more than normal sebum doing its job: lining the pore with oil. Because the sebum is meant to be there, squeezing is an exercise in futility — the oil comes back the next day, and frequent handling over time may actually damage the pore, causing it to enlarge permanently.

Favre-Racouchet Syndrome.  Because this condition is caused by severe, progressive sun damage over the course of many years, Favre-Racouchet Syndrome is most prevalent among men and women over 50. Patients are afflicted by large coalescent blackheads around the eyes and on the upper cheeks. Unlike acne blackheads, Favre comedones do not regress if left untreated; they must be surgically extracted or treated with topical retinoids.

Keratosis Pilaris, common among teenagers, is characterized by patches of tiny, red or brown, kernel-hard bumps on the arms, shoulders, buttocks and the front of the thighs. Occasionally, the condition occurs on the cheeks as well, with numerous bumps in the affected areas. Unlike acne, keratosis pilaris is usually painless and feels spiny to the touch. It tends to be more severe during the winter months when humidity is lower, and is more prevalent in arid climates.

Milia. These tiny, white bumps are found mostly in the area around the eyes. Cystic in nature, they are hard to the touch and deep in the skin. Milia may last for weeks or even months.

Peri-Oral Dermatitis.  Primarily affecting women in their 20s and 30s, this condition is characterized by patches of itchy or tender red spots around the mouth. The skin bordering the lips may appear pale and dry, while the chin, upper lips and cheeks become red, dry and flaky. It can also affect the skin around the nose.

Pseudofolliculitis Barbae.Pseudofolliculitis barbae is a longer name for the acne-like breakouts commonly called "shaving bumps."  As hairs grow back after shaving, waxing or plucking, they can curl before exiting the follicle and get trapped inside.  When this happens, irritation, swelling and infection may occur.  Not everyone gets shaving bumps and those with extremely curly hair are more susceptible.  To mitigate the effect of razor bumps, use an electric razor.  If you prefer blade shaving, use a new, single-edge blade every time.  Prep the area with warm water and use a rich shaving cream. Always shave with the grain, not against it and apply a mild toner or antibacterial gel when done.

Rosacea. Frequently mistaken for acne, rosacea is a skin condition most commonly found in adults between 30 and 60 years of age. Unlike acne vulgaris, rosacea does not involve comedones, and appears only in areas that are likely to flush when we're embarrassed, excited or hot primarily the face, neck and chest. The skin is bumpy, red and oily in appearance, and may also involve papules and pustules. Rosacea begins as an episodic inflammation, or a temporary annoyance. Left untreated, however, it can become a chronic condition, causing facial scarring. If you think you may have rosacea, it's best to contact a dermatologist right away.  See acne rosacea.